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Every so often a decision has the capacity to alter a sport forever. Only rarely does one lone ruling have the potential to shape so many lives and pose questions which strike to the very heart of the debate over identity politics.

Later this month, the Court of Arbitration for Sport (Cas) decides whether to side with or against Caster Semenya on controversial testosterone regulations, and it is not only athletics which is awaiting the verdict with bated breath. Uphold the International Association of Athletics Federations’ limitations on women with naturally high levels of the hormone – termed athletes with Differences of Sexual Development – in certain track events and there is a suggestion the “scrutiny and humiliation” will prompt some to attempt to take their own lives. Indeed, Telegraph Sport has learned this allegedly occurred as a result of a similar rule that served as a precursor to the current case.

But deny the proposed regulations and there are claims athletics will be overrun by DSD athletes, effectively forcing women with regular testosterone levels out of the sport.

There are questions of science, ethics and human rights. And in the middle of it all stands Semenya, a phenomenal runner whose pleas are simple: “I just want to run naturally, the way I was born.”

The South African’s stance has never changed since she was first thrust into this position against her wishes. In spite of the IAAF insisting these regulations do not target any specific athlete, it is Semenya who has personally brought the case to the Cas, a decade after she was outed in public when it emerged she had been made to take a sex verification test during the 2009 World Championships.

The aftermath then was similar to now. Forced to take testosterone-lowering medication under IAAF regulations implemented in 2011, she experienced a noticeable drop in performance until the Cas halted the rules four years later following a legal challenge from Indian sprinter Dutee Chand. But there is a warning that the effects of those rules in place from 2011 to 2015 ran far deeper than dampening the speed of a few women.

Payoshni Mitra, who was instrumental in Chand’s case and served as an expert for Semenya at the Cas, told Telegraph Sport: “Some of these athletes continued to compete, but suffered from several side-effects from something that was taken not for any health reason, but for sports participation. Others had to quit.

“These regulations forced people out of sport and in many cases [to become] completely forgotten. I have directly worked with athletes in Asia and Africa, some of whom have, in the eyes of the rest of the world, ‘disappeared’. The physical and psychological harm caused by being forced to quit sport or take invasive medical steps was enormous. Under these policies, athletes often tried to escape the scrutiny and humiliation by migrating to unknown places. Some of them even attempted suicide.”

Such dire warnings have prompted no shortage of support for Semenya. The United Nations Human Rights Council, Human Rights Watch, Women’s Sport Foundation and South African government are among those who have already condemned the rules. To many, there are racial undertones amid suggestions the rules largely affect African and Asian women who may not fit the Western image of femininity.

For the IAAF, there is a simple basis of maintaining fairness for all women under the logic that increased testosterone provides a significant advantage over the general female population. Told by the Cas to suspend its previous regulations in 2015, the IAAF has returned with what it believes is the weight of scientific evidence. A study it funded alongside the World Anti-Doping Agency found women with raised testosterone levels received a sizeable advantage over those with conventional levels at the 2011 and 2013 World Championships – a boost of up to three per cent in the track events they want the rule to apply to, between 400m and the mile.

Lynsey Sharp has spoken of the 'difficulties' of racing against SemenyaCredit:
Getty images

Yet the credibility of those numbers has been disputed. Despite five experts supporting the IAAF in its case at the Cas, other independent experts have accused the study of distorting evidence by including results from dopers and those taking medication with therapeutic use exemptions.

Only last month, two experts from Britain and Canada warned in the British Medical Journal of a lack of evidence about testosterone’s effects, suggesting the IAAF’s regulations risk “setting an unscientific precedent for other cases of genetic advantage”.

Despite many female athletes privately hoping the Cas uphold the regulations, public support within the sport remains scarce. British 800m runner Lynsey Sharp was vilified for tearfully talking of the “difficulties” of competing with the likes of Semenya after finishing behind her at Rio 2016 – one of two Olympic and three world titles the South African has won. This was despite Sharp having some authority on the issue – she wrote her dissertation about hyperandrogenic athletes at Edinburgh Napier University.

IAAF president Lord Coe recently suggested there was evidence of athletes’ representatives actively looking for DSD athletes, such is their physical advantage, while the organisation’s lawyer Jonathan Taylor says those women will “dominate the podiums and prize money in sport”, denying others with regular levels of testosterone any chance of victory. It is an argument that Semenya’s camp dismiss as “absurd fearmongering”.

Whether this decision marks a conclusion to the topic is debatable. Both parties have agreed to honour the Cas verdict, but routes of appeal and other courts of law remain. For Semenya, there may be no end.